As the Senate works to craft its own version of the House GOP’s American Health Care Act and polls show increasing skepticism about the Republicans’ plan, some Democrats continue to highlight the pain they say the legislation would cause rural Americans, including more than half a million Pennsylvanians living on Medicaid.
Nearly 1 of out of every 5 rural Pennsylvanians uses Medicaid following the program’s expansion under the Affordable Care Act, commonly known as Obamacare. The House of Representatives bill to replace that legislation would cut $800 million from the program, with an estimated impact of 371,800 Pennsylvanians losing Medicaid coverage, according to an analysis from the left-leaning think tank Center for American Progress.
“Usually in health care, you’re providing health care; you’re improving it,” Sen. Bob Casey, D-Pa, said at a recent news conference on Capitol Hill alongside other Democrats from the Joint Economic Committee. “This is a scheme to give very wealthy people even more. It’s repeal and decimate.”
Democrats have been left out of the Senate’s talks on its own bill so far, but they’re using the potential cuts in health coverage to criticize Republicans at the beginning of what’s expected to be a tough election season for many.
The focus on rural areas is no accident: In Pennsylvania, President Donald Trump defeated Hillary Clinton by nearly 3 to 1 among small-town and rural voters in November, according to a CNN exit poll, and the Democratic Party is chastened after being accused of ignoring rural, mostly white voters in Rust Belt states.
Casey, Pennsylvania’s senior senator, will be running for a second term in 2018 and has staked his first term in part on speaking out for rural residents.
“The Democratic Party is increasingly becoming the party of suburban and urban America,” said Terry Madonna, professor of public affairs at Franklin and Marshall College. “Casey’s interest in the working class isn’t new. He’s a little different than a lot of Democrats.”
The AHCA would leave 23 million people uninsured by 2026 while reducing the federal budget deficit by $119 million over the next decade, according to the analysis from a Congressional Budget Office report released last Wednesday.
More than 2.7 million, or 21 percent, of Pennsylvania’s residents live in rural counties, according to 2010 census data, and 19.3 percent of Pennsylvanians in rural areas receive Medicaid coverage.
Republican Rep. Glenn Thompson of Howard Township, Pennsylvania, was one of nine House members from the Keystone State who voted in favor of the AHCA when it narrowly passed the House in early May. His support didn’t waver with the CBO report.
“The American Health Care Act does not eradicate the Medicaid program. Rather it begins to slow the rate of growth in 2020, while providing states resources and flexibility to offer innovative and accessible health services,” Thompson said in a statement. “As an elected official representing the largest, most rural district in Pennsylvania, I want to see the program remain viable for the most vulnerable populations — not just today, but into the future.”
Residents of rural areas are often older, have higher rates of chronic disease and tend to need more money for health services, said Lisa Davis, director of the Pennsylvania Office of Rural Health in Penn State’s College of Health and Human Development.
She added that Pennsylvania’s rural hospitals have seen fewer patients unable to pay for care since the state expanded Medicaid as part of the Affordable Care Act. In 2015, the dollar amount of uncompensated care decreased by $92 million, or 8.6 percent, statewide, according to the Pennsylvania Department of Human Services.
Fewer insured individuals could result in the closure of hospitals, which already are difficult to come by in rural communities, Davis said. Medicaid accounts for 11 percent of hospitals’ revenue stream, according to the Joint Economic Committee’s Democratic report.
“We know what an important part of the economy these hospitals are,” said Sen. Al Franken, D-Minn.
In Pennsylvania, 48 of 67 counties are considered rural, with hospitals being the number one or number two employers in 28 of those counties. Davis said doctors were keener to practice in higher-paying urban markets, making recruitment and retention more difficult in rural facilities.
Sen. Martin Heinrich of New Mexico, the committee’s top Democrat, said senators from his party planned on emphasizing the Affordable Care Act’s strengths to Republicans from Medicaid expansion states, saying, “We’re not accepting that we’re arguing over how quickly we defund Medicaid.”
Among those is Sen. Pat Toomey of Pennsylvania. A spokesman for Toomey said no one from the other side of the aisle had reached out on how to best address Medicaid.
“Sen. Toomey has noted on multiple occasions that no one will lose their federal Medicaid eligibility,” said spokesman Steve Kelly. Toomey “is always open to the perspective of any of his colleagues, constituents and the groups that represent them.”